Due to the widespread incidence of vaginitis, the topical antifungal market has increased significantly over the years. Until relatively recently the market has been dominated by the polyene antibiotics nystatin and amphotericin B. Now, certain imidazole derivatives have been found to have antifungal, antibacterial and antiprotozoal activity. Currently, miconazole, econazole and clotrimazole, three imidazole derivatives, are marketed as antifungal agents.
The currently marketed imidazole antifungal agents are active against Candida albicans when administered topically, orally and by intravenous infusion. Actual use of these compounds is limited, however, mostly to topical application. This limitation of utility is due to such practical considerations as adverse side effects and extensive metabolism.
While Candida albicans is thought to be the principal causative agent of vulvovaginitis, Trichomonas vaginalis has also been implicated as a causative agent, and unfortunately, the antifungal imidazoles do not have good activity against this organism.